“…Patients with heterozygous germline mutations in the FH gene are susceptible to multiple cutaneous and uterine leiomyomatosis (MCUL), which is associated with an increased risk of developing papillary renal cell cancer and leiomyosarcoma ( Table 1 ) [ 35 , 36 , 37 ]. The sporadic loss of FH or transcriptional downregulation of FH was found in various cancers, such as pheochromocytomas, paragangliomas, neuroblastomas, adrenocortical carcinoma, ependymoma, osteosarcoma, bladder cancer, breast cancer, glioma, colorectal cancer, and testicular cancers [ 38 , 39 , 40 , 41 , 42 , 43 ]. Inactivation of FH compromises the TCA cycle and respiration, and tumor cells harboring mutations in FH were found to adapt to the glutamine-dependent reductive carboxylation reactions as an alternative pathway for the formation of αKG and citrate, which fuel the TCA cycle and generate NADH to feed into the electron transport chain for ATP generation and the maintenance of mitochondrial membrane potential [ 44 ].…”